- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.48 / $95.07 / $155.63
| Professional | | $84.48 | $95.07 | $155.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.02 / $111.27 / $214.48
| Professional | | $88.02 | $111.27 | $214.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.59 / $160.10 / $284.22
| Professional | | $110.59 | $160.10 | $284.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.67 / $150.15 / $383.21
| Professional | | $102.67 | $150.15 | $383.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.79 / $145.08 / $276.07
| Professional | | $100.79 | $145.08 | $276.07 |